Thursday, March 10, 2016

With the help of financial support from the
Physicians Foundation,Health Affairs, a respected source of
information on the state of national health care,devotes part of its March 2016 issue “Physicians,
Prescription Drugs, ACOs, and More “ to the impact of health reform on
physicians and patients.

In his lead editorial,the new editor,Alan Weil,JD, M.P.P., a graduate of the
University of California, the Kennedy School of Government at Harvard, and
Harvard Law School, formerly executive
director ofthe National Academy of
State Health Care Policy,makes these
cogent observations.

·Despite the goal of Health and Human Secretary Sylvia Burwell that
90% of Medicare payments will be shifted from fee-for-serviceto value-based payments by 2019,95% of current paymentsare fee-for-service.

·Physicians spend $15.4 billion compiling quality
data for the government and expend 2.6 hours a week on this task.

·Much of the burden of recording this date
falls on primary care physicians,who
spend twice as much time on the effort as cardiologists and orthopedic
surgeons.

·Accountable Care Organizations (ACOs),a linchpin of the Obama administration’s
efforts to achieve Medicare savings by herding hospitals and doctors together have had limited market penetration – only
half of ACOs include a hospital, and only 20% of hospitals participate in an
ACO.

Since its inception in 2003,The Physicians Foundation has been a
leaderin conducting national surveys on
physician attitudes and actions related to ObamaCare and it has just completed survey of patient reactions
to the health law.Health Affairs provides a forum for bringing attention to a larger
audience of physician and patient views of how the health law effects these two
vital constituencies,who,after all,represent what the health law is supposed to be all about.

As I wrote in my 2011 book The Health Reform Maze, of physicians:

“Many physicians are unhappy with the present
healthcare system and favor incremental, preferably market-driven health
reform.If health reform takes effect as
currently structured, as many as 60% of physicians may no longer accept new
Medicare and Medicaid patients or may cut back on their services.”

And of patients,

“Sometimes we forget the healthcare system existsfor patients, not for government, not for the medical-industrial complex,
and not for physicians and other health care professionals.

In any event,here are four verbatim abstracts from the March issue of Health Affairs,

How
physicians describe themselves:

“Physicians describing themselves as
independent practice owners declined from 62 percent in 2008 to
35 percent in 2014, according to the 2014 Survey of American Physicians
conducted by the Physicians Foundation. Over 70 percent of physicians
would still choose to be a physician if they could do their career over, but
many have important concerns. Over 80 percent report that they are
overextended or at full capacity and that nonclinical paperwork takes up about
20 percent of their time. Only 10 percent of physicians interviewed
in 2014 were very optimistic about the future of the medical profession.”

How physicians respond to federal quality practice
tracking:

In this issue of Health Affairs, Lawrence Casalino
and coauthors establish that physicians in common specialty practices spend an
average of 2.6 hours per week dealing with external quality measures. This
gives rise to general questions about the future of the medical profession. To
what extent will quality-tracking requirements and similar practice intrusions
reshape who physicians are, how many physicians there are, and how they
practice? In turn, how will these changes affect patients’ access to care? Data
derived from the 2014 Survey of America’s Physicians: Practice Patterns and
Perspectives, conducted by Merritt Hawkins on behalf of the Physicians Foundation,
make it clear that physician practice patterns are evolving. Responding to an
increasingly intrusive practice environment, physicians report that they will
choose a variety of practice models likely to reduce patients’ access to care
or that they will retire early, which will exacerbate the physician shortage
and fundamentally change the nature of the medical profession.

How
retail clinics affect healthcare costs

Retail
clinics have been viewed by policy makers and insurers as a mechanism to
decrease health care spending, by substituting less expensive clinic visits for
more expensive emergency department or physician office visits. However, retail
clinics may actually increase spending if they drive new health care
utilization. To assess whether retail clinic visits represent new utilization
or a substitute for more expensive care, we used insurance claims data from
Aetna for the period 2010–12 to track utilization and spending for eleven
low-acuity conditions. We found that 58 percent of retail clinic visits
for low-acuity conditions represented new utilization and that retail clinic
use was associated with a modest increase in spending, of $14 per person per
year. These findings do not support the idea that retail clinics decrease
health care spending.

How Patients View Federal Drug Benefits—Prescription And
Otherwise

A few papers in this issue explore a variety of topics
related to drugs. Marc Elliott and colleagues report that Medicare
beneficiaries are less satisfied with their prescription drug benefit than they
are with other benefits, but that those in plans that integrate the drug
benefit into a Medicare Advantage plan are more satisfied than those enrolled
in standalone plans. Kathleen Miller and Michael Lanthier find that more than
half of the new drugs approved under the Orphan Drug Act of 1983 have been
“first in class.” Finally, as states increasingly adopt medical marijuana
programs, Arthur Robin Williams and colleagues conclude that states with looser
regulations have much higher rates of enrollment.

The Health Reform Maze

Buy the Book

Book Description: In this first book in a series of four, Richard L. Reece, MD. provides a unique view of the roll out, and run up, of the Affordable Care Act. Reece shows in this book the progress and facets of ObamaCare's marketers and messengers, as the day approached for the launch of health insurance exchanges - the single most public and problematic portion of the new law. This is a must read for anyone who wants to chronicle this attempt to organize more than one-sixth of the U.S. economy by adding layers of federal government control and regulations.

Reece has been writing about U.S. health care for more than 45 years. His knowledge and experience, added to his keen intellect and gift of subtle humor, make this book a valuable part of anyone's collection.